how to evaluate the efficiency and safety of neoadjuvant chemotherapy in locally advanced cancer cervix

Conditions: Locally Advanced Cervical Carcinoma

Summary: 1. this strategy might suggest a therapeutic option to preserve ovarian function in young patients among which locally advanced cancer cervix is common. based on previous studies, neoadjuvant irinotecan and cisplatin followed by radical hysterectomy and adjuvant chemotherapy has the potential to improve the prognosis compared the concurrent chemo-radiotherapy(ccrt). 2. to offer an alternative effective treatment line replacing concurrent chemo-radiotherapy to avoid dramatic radiotherapy induced complications which might impede a safe successful surgery. 2- to reduce the proportion of patients who will go for radiotherapy, consequently those patients will still have a chance of probable less complicated surgery in case of local recurrence. 3- this study will involve neo-adjuvant chemotherapy (nact) in treating patients with stage ii-iii cervical cancer for reducing tumor size, minimizing blood loss during surgery and eradication of possible micro-metastasis. 4- to improve the likelihood of achieving complete tumor resection after nact. 5- investigators will further follow-up those patients for more detailed assessments to confirm whether nact can improve patients' prognoses, survival, quality of life, and the standard of care.

treatments for locally advanced cervical cancer, defined as international federation of gynecology and obstetrics (figo) stage ib2-iii include primary surgery, neoadjuvant chemotherapy and concurrent chemo-radiotherapy (ccrt). in many countries, ccrt is accepted as the standard therapy for such tumors. however, each of these therapies has both advantages and disadvantages, however, more recently it has been given using neoadjuvant chemotherapy with intravenous irinotecan hydrochloride (cpt-11) and cisplatin. dna topoisomerases are enzymes that regulate and control dna topology. topoisomerase 1 catalyzes the transient cutting of a single dna strand, the passage of another dna strand through the break and then resealing of the dna break. camptothecin (cpt), an antitumor alkaloid isolated from camptotheca acuminata, interferes with dna topoisomerase 1 function. cisplatin (cis-dichlorodiammineplatinums ii) is a first generation platinum compound. platinum-based nact followed by radical hysterectomy has been proposed as an alternative approach to radiotherapy or ccrt in locally advanced cervical cancer, especially of squamous cell histology, with objective response rates ranging from 69.4% to 90.2%, pathological optimal response rates ranging from 21.3% to 48.3%, 5-year disease free survival (dfs) rates ranging from 55.4% to 71% and 5-year overall survival(os) rates ranging from 58.9% to 81%, respectively.

Eligibility criteria:
inclusion criteria: 1 - patients with histologically confirmed invasive squamous cell carcinoma of the uterine cervix; (ii) figo stage system (2018 version): stage ii-iii 2- no previous treatment. 3- patients with age of 20-75 years at enrollment. 4- eastern cooperative oncology group performance status (ps) of 0 or 1. 5- preserved function of major organs (bone marrow, heart, liver and kidney) 6- lab values within specified ranges, including a neutrophil count greater than 2000/μl, a platelet count greater than 100 000/ mm3 , a hemoglobin level greater than 9.0 g/dl (values after blood transfusion are accepted), levels of aspartate aminotransferase and alanine aminotransferase less than 100 iu/l, a total bilirubin level less than 1.5 mg/dl, a serum creatinine level less than 1.5 mg/dl, creatinine clearance greater than 60 ml/ min. exclusion criteria: : 1. distinct evidence of infectious disease. 2. serious concurrent disease (cardiac disease, uncontrolled diabetes mellitus, malignant hypertension and a bleeding tendency). 3. pregnant women, or women who want to become pregnant. 4. history of serious drug hypersensitivity or drug allergy.